Uzm. Dr. Ertan Özen
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Gynaecological Procedures
Hysteroscopic myomectomy
What hysteroscopic myomectomy is, how submucosal fibroids are resected through the cervix without surgical incisions, what clinical evidence confirms regarding bleeding and fertility, approximate costs in Turkey compared with the UK, US and Germany, who qualifies under the FIGO classification, recovery expectations, procedure risks, fluid safety protocols and how to choose an accredited gynaecological surgical team.
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Prof. Dr. Zehra Neşe Kavak
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Hysteroscopic myomectomy in Turkey: what it is and how it works
Hysteroscopic myomectomy is a minimally invasive gynaecological operation designed to remove submucosal uterine fibroids—non-cancerous growths situated directly beneath the uterine lining that bulge into the uterine cavity. Unlike open or laparoscopic procedures, this intervention requires no abdominal or vaginal skin incisions. A thin, illuminated surgical telescope called a resectoscope is passed through the vagina and the natural opening of the cervix into the uterine cavity, allowing the surgeon to visualise the endometrium and shave away fibroid tissue in controlled layers.
Submucosal fibroids frequently cause debilitating menorrhagia (heavy, prolonged menstrual periods), iron-deficiency anaemia, severe pelvic cramps, and fertility challenges. Women seeking hysteroscopic myomectomy in Turkey choose accredited hospital facilities with experienced minimally invasive gynaecological teams. For an overview of related care pathways, see our guide to gynecology treatments in Turkey.
How is submucosal fibroid resection performed step by step?
The operation takes place in an operating theatre under general or spinal anaesthesia so that you remain completely comfortable. The surgical sequence follows precise clinical stages to ensure clear visualisation and protect the uterine muscle wall.
After positioning, the cervix is gently dilated with calibrated surgical dilators. The surgeon introduces the resectoscope, an optical instrument fitted with a camera, irrigation channels, and an operative element. Sterile isotonic saline is continuously infused under controlled pump pressure to distend the uterine cavity. This expands the endometrial folds and clears minor bleeding to maintain a continuous, unobstructed view.
The surgeon then deploys an electrosurgical loop or a mechanical morcellator. A bipolar loop uses high-frequency electrical current to shave the fibroid into thin chips from its apex to its base. Alternatively, a mechanical tissue removal device morcellates and aspirates tissue fragments simultaneously. The base is levelled flush with the surrounding myometrium without injuring the underlying muscle. Operating time usually ranges between 30 and 60 minutes.
Does hysteroscopic myomectomy improve bleeding and fertility?
Clinical evidence strongly supports hysteroscopic resection for intracavitary fibroids. The Royal College of Obstetricians and Gynaecologists (RCOG) and the American College of Obstetricians and Gynecologists (ACOG) recommend it as the primary surgical standard for submucosal fibroids causing abnormal bleeding.
For menorrhagia, published studies confirm that 80% to 90% of women achieve substantial reduction in menstrual blood loss and resolution of anaemia within two to three cycles. Removing the intracavitary mass allows the endometrial lining to shed and heal uniformly.
Regarding fertility, submucosal fibroids impair embryo implantation through mechanical distortion, local inflammation, and altered endometrial blood supply. Resection of FIGO Type 0 and Type 1 fibroids significantly improves spontaneous conception and IVF success rates, returning them to levels comparable with women who have no fibroids. However, it cannot treat intramural or subserosal fibroids located deeper within or outside the uterine wall.
Hysteroscopic myomectomy cost in Turkey compared with the UK, US and Germany
The overall hysteroscopic myomectomy cost depends on fibroid size and classification, whether a one- or two-stage resection is required, anaesthesia, and the surgical system used. The approximate price ranges below compare private hospital costs across major destinations.
| Country | Approximate cost range |
|---|---|
| Turkey | €1,800 – €4,200 |
| United Kingdom | €4,500 – €9,500 |
| United States | €6,000 – €14,000 |
| Germany | €3,500 – €8,000 |
In Turkey, hospitals package treatment to include pre-operative bloods, pelvic ultrasound, theatre fees, surgeon and anaesthetist fees, histopathology analysis of resected tissue, medications, and airport transfers. When comparing hysteroscopic myomectomy price options, ensure pathology and fluid monitoring fees are explicitly included in writing.
Hysteroscopic myomectomy, laparoscopic surgery or uterine artery embolization?
Choosing the right procedure depends on the anatomical location of your fibroids, your symptom severity, and your fertility intentions.
| Procedure | Best suited to | Typical limits |
|---|---|---|
| Hysteroscopic myomectomy | Submucosal fibroids inside cavity (FIGO 0, 1, select 2) | Cannot reach intramural or subserosal fibroids |
| Laparoscopic / open myomectomy | Multiple large intramural or subserosal fibroids | Requires abdominal incisions; 4–6 weeks recovery |
| Uterine artery embolization (UAE) | Symptomatic fibroids in women not planning pregnancy | Not ideal for future fertility; potential ovarian impact |
Hysteroscopy leaves the uterine outer wall untouched and creates no abdominal scars. Laparoscopic or open myomectomy requires incising the abdomen and uterine wall to remove deeper fibroids. Non-surgical uterine artery embolization blocks blood supply to shrink fibroids, but is usually reserved for women who have completed childbearing.
Which fibroid types and sizes can be removed through the cervix?
Fibroids are categorised according to the International Federation of Gynecology and Obstetrics (FIGO) classification:
- FIGO Type 0: Pedunculated fibroids located entirely within the uterine cavity, easiest to remove in one session.
- FIGO Type 1: Submucosal fibroids with over 50% of their volume inside the cavity, routinely resected with high success.
- FIGO Type 2: Fibroids with less than 50% intracavitary extension and a substantial intramural component, often needing a planned two-stage procedure.
Size is also a deciding factor. Most surgeons establish a threshold of 4 to 5 centimetres for a single procedure. Beyond this, fluid absorption safety limits may be reached before full excision, requiring a second session 6 to 8 weeks later once residual tissue migrates into the cavity. The procedure builds on standard diagnostic hysteroscopy, using wider operating sheaths for continuous flow.
Before and after hysteroscopic resection: what results can you expect?
Because this is an internal therapeutic operation rather than cosmetic surgery, "before and after" results reflect symptom relief and diagnostic imaging rather than external appearance.
Prior to surgery, patients often experience prolonged bleeding of 7 to 10 days with heavy clotting, iron-deficiency anaemia, and chronic fatigue. Following complete resection, most women see their periods become markedly lighter and more manageable within one to three cycles, allowing blood counts to recover naturally.
Anatomically, follow-up pelvic ultrasound or saline infusion sonography at 6 to 8 weeks confirms a clear, smooth uterine cavity. Women pursuing pregnancy are typically advised to wait two to three menstrual cycles before attempting conception, giving the endometrial lining sufficient time to re-establish a healthy receptive surface for embryo implantation.
Who is a suitable candidate for hysteroscopic fibroid removal?
Good candidates are pre-menopausal women with symptomatic intracavitary fibroids confirmed by transvaginal ultrasound, saline infusion sonogram, or MRI. Common indications include abnormal menstrual bleeding resistant to medical therapies, dysmenorrhoea, or reproductive issues associated with cavity-distorting tumours.
Hysteroscopic resection is not appropriate if fibroids are entirely intramural or subserosal. Absolute contraindications include active pelvic infection, unexplained vaginal bleeding, pregnancy, or confirmed genital malignancy. Patients with co-existing cervical cell changes may require cervical evaluation or conization to ensure cervical tissue is healthy before undergoing mechanical dilation.
Travel to Turkey and hysteroscopic myomectomy recovery timeline
Patients traveling to Turkey typically stay for 3 to 4 nights. You arrive two days before surgery for consultations and pre-operative bloods. The procedure is performed as a day case or with one overnight hospital observation, and a final ultrasound check is conducted before you fly home.
The hysteroscopic myomectomy recovery timeline is brief because no muscle or skin incisions are made:
- Days 1–2: Mild menstrual-like cramps easily managed with paracetamol or ibuprofen. Light vaginal spotting or watery discharge is expected.
- Days 3–7: Most women return to daily routines and light desk work. Walking is encouraged to promote circulation.
- Weeks 2–4: Watery discharge gradually fades as the endometrium heals. Pelvic rest must be strictly observed: no tampons, no intercourse, and no swimming or bathing to avoid infection.
- Weeks 4–6: Your first normal menstrual period occurs. Normal exercise and physical routines can be resumed after medical clearance.
Risks, fluid safety and potential complications
Hysteroscopic myomectomy has an established safety profile when performed by trained gynaecologists, but like all surgical procedures it carries potential risks identified by organisations such as NICE and ACOG.
The main procedural risk is fluid overload. Distending the uterine cavity with fluid can lead to systemic absorption through open venous channels, potentially causing electrolyte dilution. Accredited surgical centres prevent this by using bipolar instruments with isotonic saline and automated fluid-monitoring pumps that track fluid deficits in real time, pausing surgery if safety limits are approached.
Additional complications include uterine perforation (occurring in fewer than 1% of cases), bleeding, post-operative endometritis, cervical tears during dilation, and intrauterine adhesion formation (Asherman's syndrome). In large FIGO Type 2 fibroids, an incomplete resection may be chosen intentionally to avoid myometrial perforation, scheduling a second resection after the remaining tissue migrates inward.
Choosing a gynaecological surgeon in Turkey and questions to ask
When selecting a clinic for hysteroscopic myomectomy Turkey, verify that your surgeon is a board-certified gynaecologist with subspecialty training in operative hysteroscopy. The intervention should take place in an accredited hospital with an anaesthetic team and real-time electronic fluid-monitoring equipment.
Red flags include clinics quoting without reviewing imaging, facilities performing extensive resections without hospital backup, or guarantees that all fibroids can be excised in a single sitting. To understand our patient pathway, review how it works and submit your medical imaging through our free quote page.
Key questions to ask your surgical team:
- What FIGO stage are my fibroids, and is a single-stage resection realistic?
- Do you use bipolar resectoscopy with isotonic saline and automated fluid monitoring?
- What is your procedure if fluid deficit limits are reached during surgery?
- Is histopathological examination of the excised tissue included in the quote?
- How many days do you recommend staying in Turkey before my flight?
- Who coordinates my follow-up care once I return home?
Hospitals with Gynaecology in Turkey
Frequently asked questions
Hysteroscopic myomectomy is a minimally invasive gynaecological operation that removes submucosal fibroids from inside the uterine cavity. A lighted telescope (resectoscope) is passed through the vagina and cervix into the uterus, shaving away fibroid tissue in thin chips without any external skin incisions on the abdomen.
Yes. Clinical evidence confirms that 80% to 90% of patients experience significant reduction in menstrual bleeding and relief from anaemia within two to three menstrual cycles. By clearing the fibroid mass from the uterine cavity, the endometrial lining can shed and heal uniformly during each cycle.
In Turkey, hysteroscopic myomectomy generally costs between €1,800 and €4,200, compared with €4,500 to €9,500 in the UK. The exact price depends on fibroid size and classification, whether a second session is needed, and whether private hospital packages include pre-operative tests, anaesthesia, and transfers.
Because this is an internal surgical procedure, results are clinical rather than visible externally. Patients move from heavy, clot-heavy bleeding and fatigue to lighter, predictable periods. Anatomically, follow-up ultrasound or saline sonogram at six to eight weeks shows a clear, regular uterine cavity with a healthy endometrial lining.
Recovery is rapid because there are no abdominal wounds. Most patients resume light walking immediately and return to desk work within three to seven days. Pelvic rest (avoiding tampons, intercourse, and baths) is required for two to four weeks to allow the uterine lining to heal fully.
The operation itself is performed under general or spinal anaesthesia, so you feel nothing during the procedure. Afterwards, most women experience mild menstrual-like cramping and pelvic pressure for one to three days, which is well managed with standard over-the-counter pain relief such as paracetamol or ibuprofen.
The specific fibroid tissue resected does not grow back. However, hysteroscopic myomectomy does not alter your underlying hormonal or genetic predisposition, meaning new fibroids may occasionally develop in other parts of the uterine wall over time. Regular gynaecological monitoring helps detect any recurrent growths early.
For submucosal fibroids, hysteroscopy carries fewer complications than open surgery because it avoids abdominal incisions, reduces blood loss, eliminates abdominal adhesion risks, and enables same-day discharge. However, it requires careful operating theatre fluid monitoring to prevent fluid overload from cavity irrigation.
Hysteroscopic myomectomy physically resects the intracavitary fibroid through the cervix, preserving the surrounding uterine muscle and restoring the cavity for pregnancy. Uterine artery embolization blocks blood supply to shrink fibroids without surgery, but is generally reserved for women who have completed childbearing.
Most patients stay in Turkey for three to four nights. This allows sufficient time for pre-operative consultations and pelvic ultrasound on arrival, the surgical procedure with day-case or overnight hospital observation, and a follow-up assessment before flying home safely.
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